Planning for Birth During the COVID-19 Crisis
Times are tough. There's no way around that truth. Everyone I know is struggling amidst the coronavirus outbreak as COVID-19 is impacting every part of our lives. For pregnant women and families, coronavirus has made an already intense time of life feel more scary and more unknown than it usually is. Many of the beautiful aspects of pregnancy, like planning a baby shower with visiting friends and family or taking maternity photos, are being put on hold or cancelled altogether. If you're feeling down about all this, you're not alone. Every pregnant client of mine has expressed high levels of anxiety over the illness, remorse over the loss of celebration during pregnancy, and general fear around planning to give birth in a place where the virus is most likely to be present-the hospital.
In Orange County, birthing people are already seeing huge shifts in their birth plans due to hospital restrictions and shifting public policies. I thought it would be prudent to help my clients and anyone else birthing in or around Orange County, CA by providing some perspective on these birthing restrictions and listing my suggested steps for birth preparation during these crazy times. It's my hope that my suggestions here bring some small amount of calm to the stressed out hearts of expecting families.
First, I want to offer up some incredible resources that birthing families have at their disposal. If you're curious about how COVID-19 affects pregnancy and birth or want to learn more about mother-to-baby transmission rates, Evidence Based Birth is compiling ongoing research and updating consumers often. The American College of Obstetricians and Gynecologists also has a resource page about pregnancy and coronavirus. The organization Birth Monopoly has also compiled an ongoing directory of hospital policy restrictions due to COVID-19 that I hope to see expanded in the coming weeks.
If you're expecting a baby soon and you're wondering what the deal is with local Orange County hospitals, the majority are currently still allowing one (1) support person into the Labor and Delivery unit with the person giving birth. There is a strict ban on second support persons (usually doulas, though some birthing women are opting for their doulas to be primary and their partners to stay home). There's also a ban on children visiting in most hospitals, which makes this whole no school/no childcare situation a pretty big deal for many families right now. Some birthers are having to go solo through birth because the family member who would have stayed with kiddos during labor are either ill or unable to travel due to this coronavirus.
I caution families contacting me for support to plan flexibly during this time, as hospital policies are shifting frequently as risk is assessed and reassessed. It is likely that Orange County will see at least some hospitals banning all support people from L&D units if other hard-hit areas are an example of what's to come. Many hospitals in New York are already at this place with their policies. There are also reports of women being separated from their babies if they test positive for COVID-19. The sad truth about this situation is that we have no idea if these bans or separation policies are actually healthy for anyone involved. It's too soon, we don't have enough research, and hospital staff are doing their best to keep their heads above water. But does that mean that birthing people's rights should be stripped in case it might save some from getting COVID-19? I don't have the answer to this question, and neither do care providers.
As a long-time doula, childbirth educator, and perinatal health advocate, I am not surprised by the restrictive mandates in L&D hospital floors across the country during this COVID-19 pandemic. Those who give birth within the medical system have faced a stripping of human rights since birth in the U.S. began shifting into the hospital setting in the early 1900s. Whether we're talking about forced use of ether to sedate the "hysterical" woman, denying the basic need for food and drink throughout labor, or barring partners and support people from being present at birth, hospital policies have exerted control over the birther's every move for over a century. Most of the positive shifts we have seen in hospital births in recent decades (inclusion of birth support people, lowering of Cesarean rates, the shift toward evidence-based protocols) have been driven by external education of the public, actions from advocacy groups, and ultimately consumer demand. It is not shocking to me, then, that the instant it seems reasonable enough to do so, such as during a period of widespread panic, hospital administrators roll back policies to restrictive states. It is the very nature of the hospital model to limit, dictate, and streamline for efficiency's sake. Add in a global health crisis where demand for accountability and change is less likely, violations and abuse are bound to occur.
The current argument for the restriction of labor partners in Orange County hospitals is that more people inside the hospital means more potential for exposure to COVID-19 to folks inside the hospital. I understand this concern, especially on the part of hospital staff who are encountering hundreds of sick and dying people a day. However, I would argue that L&D admits are those least likely to be sick when entering the hospital right now. They definitely pose less of a threat than ER visitors and the like. Additionally, L&D units are quite separate from the general population in hospitals, often occupying an entirely distinct floor or wing. In fact, this is one of the arguments hospitals make when giving L&D tours to inquiring families: we're safe enough for birthing people to come in and stay a few days because this part of the hospital is segregated and the staff here only works with lower risk populations.
What restrictive partner policies cause in real-time for nurses and mothers is beyond unfair. For pregnant people, the person they feel most comfortable with emotionally is also the person they are already sharing space with at home. It makes no sense for the woman to suddenly be separated from her partner from a health perspective. If anything, this action will put women more at risk for illness because nursing staff on rotating shifts will inevitably end up being more hands-on. Where partners would usually be able to meet the patient's needs for comfort, food or drink, support in position changes, etc, now nurses will be entering the room more frequently. This means that nurses will be stretched thinner than they usually are and birthing people will be left alone much of the time. Mistakes in charting will occur, reminders to staff about important medical information will go unsaid while the mother is in an altered headspace in labor, trauma levels will spike, and maternal health everywhere will suffer.
So, what are expecting parents to do about this? While advocacy and consumer groups write strongly worded letters that may never be read, parents are marching toward birth in a hospital with even more trepidation than is usual around the end of pregnancy. Anxiety levels are naturally up and women are looking for ways to cope through this nightmare. In an effort to help birthing families find some semblance of control and calm moving toward birth in a hospital, I've put together a list of actionable steps expecting parents can take.
Consider a home birth or birth center experience. This may be an absolute no-go for your body or family, and that's okay. Home birth is not safe for everyone, mentally or physically. It could also be too costly for your family at a time when economic uncertainty is the name of the game. However, if you are low-risk and in an area that midwives serve, you might find yourself gravitating toward this option for the privacy and peace of mind it offers. You won't ever be separated from your partner or baby at home and you'll be minimizing your risk of transmission by working with a small team of care providers (usually one or two midwives, a birth assistant or doula, and your family) from start to finish. If it is a possibility at all or you're just unsure if you are low-risk enough for an out of hospital birth, reach out to a couple local midwives to see if home birth or a birth center birth makes sense. If you're in or around Orange County, Long Beach, or surrounding cities, shoot me an email and I'll share which midwives have availability for your due date.
Hire a doula. A doula can* still provide in-home support prior to going to the hospital, which could mean a lot less time spent in the hospital during labor. The doula can also offer helpful guidance via phone or video chat once you're there or be the primary support person if you would prefer. Have a question about something your care provider is suggesting? Call your doula. Need to hear some reassuring words when you've hit a wall? Call your doula. Need breastfeeding help and there's a shortage of nurses available in the postpartum unit? You get it. Many doulas are offering sliding scale fees to help pregnant families impacted by the coronavirus pandemic. *Some doulas are offering only virtual support during this time to protect their own families.
Download Zoom/Skype for free and practice using the apps with your doula and/or birth partner. Facetime can work too, though I generally see worse connectivity. Live streaming throughout labor might help you feel connected to your support team and ward off the intense feelings of isolation that may arise. Call ahead to your hospital and get the wifi information. You might need to assert your right to stay connected via video chat during birth since many hospitals have/had a no-video policy in place for liability purposes. Assure the staff that you are not recording, but are accessing much-needed comfort and guidance.
Pack two bags in case you get separated last minute. Maybe you just called the hospital the day before your labor began and they confirmed you can take your partner with you. Things are shifting so quickly right now that you may arrive at the hospital to learn differently. Have all of your necessities ready in a go bag separate from your partner's just in case a last-minute deviation from your plan occurs.
Create a flexible birth wish list for yourself and your hospital staff. You may have spent months preparing for a specific type of birth only to find that what you are able to do or what you actually want in labor differ from that original vision. I suggest nixing any rigid expectations of yourself right here and now if you're having to birth alone. Opt for compassion for your vulnerable self. You don't know what's to come, so you can't hold yourself or your nursing staff to a checklist of musts the way you could if you had your doula or partner there. If you wanted to labor without medications but now have zero in-room support to cope with the pain of labor, choosing an epidural might be the next best step for you. If you had planned to request only intermittent monitoring but now think you'd prefer to be set up once for continuous monitoring to limit contact with nurses, that's a reasonable choice too. The truth of the matter is that no one ever knows how they will feel in labor until it is happening, so being flexible with yourself is always helpful. It's just that much more important during the COVID-19 pandemic because you can't adequately prepare for what resources will be available to you.
Consider recording your doula or birth partner's voice to listen to during labor. Many birthing people find comfort in listening to guided meditation and hypnosis tracks during birth. There are countless playlists for this on YouTube already. But for many of my doula clients, the most comforting voice of all is the spouse or partner's. There are "birthing scripts" and "visualization scripts" available all over the internet. Select one that resonates with you and ask your partner to do a simple recording of it as if you were in labor and needed help focusing or coping.
Bring your own comfort tools. You'll probably already have a list of musts to pack that includes things like your ID, phone, charger, etc. If possible, bring items that would make you feel better emotionally or physically. Ask for a cart on your way in if your partner is not allowed to carry things in. My suggestion for priority items: an eye mask to rest/sleep; a pillow or blanket of your own; something to do with your hands and brain during labor (think coloring book or handheld game); a silicone breast pump; and (can't stress this one enough) FOOD. Hospital food is already known for being blah. Now you may not have a chance to get outside food during your stay because your partner wasn't allowed in at all or because that person isn't allowed to leave and come back. You will want food at some point during labor or the postpartum period and the pitiful turkey sandwich provided will not be enough.
Advocate for an early discharge, if possible. Most hospitals require a 24-hour stay post-birth, and this is usually for baby more than mom. A pediatrician typically has to sign off on baby's well being before discharge can occur. However, it is possible to request an earlier discharge time and/or to sign yourself out against medical advice. Now, of course, you'd want to consult with your providers and nursing staff to ensure you're all well and healthy to go home, but I've had clients check out of the hospital 4-6 hours after birth knowing they'd be seeing a pediatrician soon thereafter. There's an argument to be made here that especially in this time, you'd be MUCH safer at home with your little one and partner than in the hospital room interacting with half a dozen nurses and health aids.
None of these suggestions are a ticket to a trauma-free birth. Even if you do ALL THE THINGS, birth in this intense time might be challenging. A personalized childbirth class could help you understand some of the medical information that will be thrown your way and your options for progress. Reading about your rights as a patient might make you feel more powerful and autonomous when you enter the hospital. Ultimately, though, practicing your coping skills (for pain and general life stressors) is the greatest investment you can make if you're expecting to birth in a hospital soon. If you don't know where to start or want step-by-step guidance from a veteran doula, reach out for a pregnancy consultation today.
About the author: Amanda Cagle is the owner of Your Birth Team, a full-service perinatal education and support practice. She serves Orange County, CA and surrounding cities and has been a doula since 2011. Amanda provides compassionate, evidence-based care to families of all types and offers extensive financial aid to families who qualify for Medi-Cal, SNAP benefits, TANF or WIC.